Nerve Inflammation pain for months following recurrent herniation

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deritis
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April 16, 2014 at 3:39 am

Post count: 18

#10743

Dr.
Been a while since I’ve been here — you helped me immensely last year on this forum. I had a very painful herniation at L5/S1. Had surgery. One month later the disc reherniated, not as severe but the pain was still bad. It has been 4.5 months since recurrence and things have improved, but not by much.

I had an epidural a month ago that did wonders. I had a second ESI recently and the pain has overall gotten worse. One Celebrex brings it down to less than a 1. At the end of this month it will have been five months since recurrence and six months since surgery. My doctor says the nerve is still inflamed. Since I have had three total ESIs in the last six months, I cannot have any more. A second surgery seems like it would be excessive. I have no muscle weakness, no nerve damage, and I am pretty much fully functional – though I have seriously reduced my gym time. But the pain continues.

I don’t even know if the recurrent herniation is still there or shrunk down. There are days/hours when the pain is almost gone and days/hours when it’s there. I am on a low dose of Gabapentin and I probably only need NSAIDs a couple times a week at worst. Will the nerve inflammation ever finally resolve (seems like it should have by now), or do I need to accept that I will be in pain for the rest of my life?

Donald Corenman, MD, DC
Moderator

April 18, 2014 at 1:02 am

Post count: 8660

#10756

For disc herniations that do not cause motor weakness, pain is the guide for treatment. Can you tolerate the pain and are you satisfied with your current limitations?

A second surgery might be something to consider if you are not satisfied with your progress. The other option is to continue to rehabilitate with therapy and see if you progress.

Over time, you can improve without surgery but how much of this progress is unknown. You do have some current evidence to compare as it has been four months since the recurrent herniation. Are you much better than you were or are you at a status quo regarding your symptoms?

Possibly a new MRI would shed some light on the significance of the recurrent herniation.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

deritis
Member

April 30, 2014 at 12:16 pm

Post count: 18

#10852

Pain is definitely the guide. I have never had motor weakness or nerve issues of any kind, other than pain. Explosive debilitating pain prior to surgery, a more consistent achy pain after reherniation. It is improved since reherniation, but not by much. MRI showed a rather small recurrence that the doctors described as what appeared to be some disc material. But it showed a significant enhancement of the nerve. I have no limitations at all, other than psychological — it hurts and I have concerns about causing further damage. Basic NSAIDs virtually eliminate pain altogether (though I am on Celebrex to reduce chances of intenstinal issues — works great). Have had two ESIs that helped greatly for a few weeks each. Seems that something that is so easily dealt with by OTC nsaids should have gotten better by now. Appreciate the advice. Thank you for the insight.

Donald Corenman, MD, DC
Moderator

April 30, 2014 at 8:23 pm

Post count: 8660

#10857

The nerve sounds inflamed “‘MRI’ showed a significant enhancement of the nerve”. This inflammation can also be associated with scar tissue that can make the nerve immobile. These nerves need to be able to move in the canal by as much as a centimeter.

There are times that a small recurrent herniation can create as much compression as the original large herniation due to the nerve root being “bound down” and unable to “move” out of the way of this small herniation.

Nonetheless, if Celebrex allows great relief and you have no cardiac or gastrointestinal problems, use this medication and be patient.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

deritis
Member

April 30, 2014 at 11:06 pm

Post count: 18

#10860

In these instances does the nerve eventually unbind? Or does it otherwise find a way to settle and return more or less to normal?

Donald Corenman, MD, DC
Moderator

May 1, 2014 at 6:31 am

Post count: 8660

#10862

The nerve will somewhat continue to be adhered but over time with stretching (hamstring stretches which also stretch the L5 and S1 nerves), this nerve can loosen up. The inflammation over time can reduce also which is the big factor in reduction of symptoms.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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Donald Corenman, MD, DC

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Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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